Concussion Management of the Student-Athlete Jason Rodriguez, MS, LAT, ATC Athletic Training Coordinator Imperial Health

Disclosures None

Concussions

Definition of Concussion A concussion is the result of a physical, traumatic force to the head, neck, or body which produces altered neurological function that may last for a variable amount of time.

National Federation of High Schools 2002 Recommendations If an athlete experiences a concussion, the NFHS return to play guidelines would allow an athlete to return to play once symptom free for 15 minutes 2011 Recommendations No athlete should be allowed to return to activity on the same day of a concussion NFHS free on-line course

Causes of Concussion Caused by a bump, blow, or jolt to the head or body that results in rapid movement of the head Does not require head contact

Occurrence of Concussion Symptoms are unique for each athlete 2.5 -3.8 million concussions occur each year Not exclusive to football Soccer, wrestling, basketball, and cheerleading also have a high rate of concussions

Signs of a Concussion Most do not lead to loss of consciousness Symptoms may show up hours or days after the injury

Signs of a Concussion Appear to be dazed or confused Forgets plays or assignments Unsure of game, score, or opponent Answers questions slowly Behavior or personality change Seizure/Convulsion Moves Clumsily Forgets events before/after the hit

Symptoms of a Concussion Amnesia Confusion Headache Sensitivity to light or noise Nausea Feeling Sluggish

Symptoms of a Concussion Loss of Consciousness Balance Problems Double or Blurry vision Concentration/Memory problems Slow reaction time Feeling unusually irritable

Diagnosis of a Concussion “A blow, jolt, or bump to the head or body that results in any of the signs or symptoms of a concussion”

Prevention Cannot be eliminated Precautions can reduce the risk of injury and help student athletes recover Football helmets (well fitted), soccer head gear, and mouth piece

Memory Function “Orientation” Failure to answer all questions correctly may suggest a concussion “Where are we at today?” “Which half is it now?” “Who is the President?”

Memory Function Anterograde Amnesia Retrograde Amnesia Elbow, Apple, Carpet, Saddle, Bubble Retrograde Amnesia “Who scored last in this game?” “What play was called prior to your hit?” “Do you remember the hit?”

Memory Function Concentration 493 3814 62791 718462

Balance Testing Series of three (3) – 20 second tests with different stances Double Leg Stance Single Leg Stance Tandem Stance

Balance Testing Observe the athlete for 20 seconds. Count the number of errors, such as lift their hands off their hips, open their eyes, lift their forefoot or heel, stumble or fall, or remain out of the start position for more than 5 seconds.

Memory Function Word List Memory Ask the athlete to repeat the 5 words from earlier

On-Field Recommendations Any athlete with a suspected concussion should be: IMMEDIATELY REMOVED FROM PLAY Urgently assessed medically Should not be left alone Should not drive a motor vehicle

Complications If any of the following are present, EMS should be activated and the patient should be transported to hospital immediately: Loss of consciousness Irregular breathing Persistent vomiting Seizures

Return to Play Protocol Athlete must be re-evaluated within 24 hours If athlete is no better or gets worse, it may require a CT scan If exam is normal and athlete has been asymptomatic for 24-48 hours, proceed with step-wise return-to-play protocol

Return to Play Protocol Once asymptomatic, athlete should be gradually re-inserted into the classroom setting

Return to Play Protocol Step 1 – Light Aerobic Exercise Walking, stationary bike, swimming, light jog No weight lifting or resistance training Step 2 – Sport Specific Exercise Running, cutting, jumping, and shooting in the gym or on the field without helmet or other equipment

Return to Play Protocol Step 3 – Non-Contact Training Drills Progression to more complex drills in full uniform May begin weight lifting, resistance training, and other exercises Step 4 – Full Contact Practice Following medical clearance, return to normal activities Step 5 – Return to Play

Return to Play Protocol If symptoms recur during any of the 5 steps, athlete must repeat the last attempted step once asymptomatic for at least 24 hours.

Return to Play Protocol Subsequent concussions may warrant a longer rest period depending on the athlete’s longevity of signs/symptoms present.

Summary When in doubt, sit them out!